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血清cTnI、CKMB和Mb浓度动态变化对急性心肌梗死的诊断价值 　　作者：王元松,刘成玉　　作者单位：青岛大学医学院，山东 青岛 266021 临床技能学实验室;诊断学教研室 　　【摘要】 目的 探讨血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CKMB)和肌红蛋白(Mb)浓度的动态变化对急性心肌梗死(AMI)的诊断价值。方法 采用ELISA法检测了40例AMI病人不同时间血清cTnI、CKMB和Mb浓度的变化，同时对血清cTnI、CKMB和Mb浓度进行了受试者工作特征曲线(ROC)分析。以40例健康查体者作对照。结果 AMI病人胸痛发作后不同时间的血清cTnI、CKMB浓度明显高于对照组(F=72.679、109.768，q=3.049～27.652，P0.01)，且胸痛发作后不同时间浓度比较，差异有显著性(q=2.863～22.133，P0.05、0.01);胸痛发作后3～6 h、1 d血清Mb浓度明显高于对照组、胸痛发作后3 d和7 d(F=17.729，q=6.175～8.688，P0.01)。且cTnI、CKMB对诊断AMI的灵敏度、特异度、准确度、约登指数、阳性预测值(PPV)和阴性预测值(NPV)明显高于Mb。AMI病人胸痛发作后3～6 h血清CKMB对诊断AMI的准确度高于cTnI和Mb，1 d、3 d血清CKMB与cTnI诊断AMI的准确度相同，但优于Mb，而胸痛发作后7 d时cTnI对AMI诊断的准确度明显优于CKMB。AMI病人胸痛发作后3～6 h和1 d时cTnI、 CKMB的AUCROC高于Mb，7 d时cTnI的AUCROC高于CKMB，且不同时间的cTnI和CKMB的AUCROC均大于0.9。结论 血清cTnI、CKMB和Mb浓度的动态变化对AMI具有明显的诊断价值和较高的准确度。 　　【关键词】 心肌梗死,肌钙蛋白,肌酸激酶,肌红蛋白 实验室技术和方法 　　[ABSTRACT] Objective To assess the value of dynamic changes of serum creatine kinase isoenzyme (CKMB), cardiac troponin I (cTnI), and myoglobin (Mb) in the diagnosis of acute myocardial infarction (AMI). Methods The serum cTnI, CKMB and Mb of 40 patients with AMI at different time were determined by enzymelinked immunosorbent assay, 40 healthy subjects servered as controls. The serum cTnI, CKMB and Mb were analyzed by receiver operating characteristic (ROC) curve. ResultsThe serum cTnI, CKMB and Mb concentration of AMI patients after the onset of chest pain at different time was higher than that of the controls (F=72.679,109.768;q=3.049-27.652;P0.01), and the difference of the concentrations at different time after chest pain was significant (q=2.863-22.133;P0.05,0.01). The serum Mb at 3-6 h after chest pain was significantly higher than that of after 3 and 7 days (F=17.729,q=6.175-8.688,P0.01). CKMb and cTnI were superior to Mb in the diagnosis of AMI in terms of sensitivity,specificity, accuracy,Yuedeng index,positive predictive value(PPV)and negative predictive value (NPV). The diagnostic accuracy of serum CKMB was higher than cTnI and